https://doi.org/10.1007/s00392-024-02526-y
1Herz- und Diabeteszentrum NRW Klinik für Elektrophysiologie/ Rhythmologie Bad Oeynhausen, Deutschland
Background: Arrhythmia ablation in close proximity to the right phrenic nerve (RPN) is a challenging procedure on account of the possibility of irreversible injury to the phrenic nerve. There are currently no data regarding the optimal ablation technique for arrhythmias that originate in close proximity to the RPN.
Objective: The aim of this study was to evaluate safety and effectiveness of utilizing a very high-power short-duration (vHPSD) ablation approach with a power output of 90 watts over 4 seconds for targeting arrhythmias adjacent to the RPN.
Methods: This research includes data from 19 patients who had catheter ablation of atrial arrhythmias originating in close relationship to the RPN or who underwent superior caval vein isolation (SVCI) as part of an atrial fibrillation (AF) ablation procedure (AF), using vHPSD. We analyzed the data about the success rate of the procedure, rates of complications, and arrhythmia recurrence.
Results: A total of 19 patients (mean age 71±16 years, 35% male) were included in this analysis. 73.7% of the patients presented with atrial tachycardia (n=14), and 26.32% received SVCI related to AF ablation (n=5). The mean procedure duration was 77.23±12.73 min. and the mean fluoroscopy time was 3.14±1.56 min. There were no procedure related complications. Notably, no RPN palsy was reported in any of the patients, even when ablation was performed very close to or directly at the location of the RPN (Figure 1). Over the course of an average 12-month follow-up, one patient (10.53%) experienced AT-recurrence and another developed an AF-recurrence.
Conclusion: The use of vHPSD ablation is both safe and effective for treating arrhythmias that around the RPN. In this investigation, no phrenic nerve injuries were detected. The presence of broad lesions, lacking in depth, can be accounted for by employing the vHPSD strategy. Additional research is required to validate these preliminary findings.
Figure 1:
Ablation of an atrial tachycardia (AT) directly at the anatomical location of the right phrenic nerve (RPN). A) Activation map of the AT with earliest activation at the RA-SVC junction. B) Visualization of the relationship between the RPN (blue tags) and the earliest myocardial activation. C) Ablation using vHPSD (90 watts; red tags).